Healthcare Provider Details

I. General information

NPI: 1063426393
Provider Name (Legal Business Name): TROY W. STOVALL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MEDICAL PARK DR SUITE 100
LENOIR CITY TN
37772-5640
US

IV. Provider business mailing address

1212 DREAMVIEW LN
KNOXVILLE TN
37922-0616
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-6600
  • Fax: 865-271-6601
Mailing address:
  • Phone: 865-288-0223
  • Fax: 865-288-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001581A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: